Key Points:
• Heat brings nutrient-rich blood to the injury site, while ice constricts the blood vessels, hindering the body’s natural healing process.
• Ice can be used for pain and swelling in the first 24 hours, but heat will always be more beneficial for long-term healing.
• It seems like an age-old question at this point: when should you use heat or ice when treating an injury at home? From sprained ankles to low back pain to joint pain, there seems to be a different answer from everyone you ask, but the truth is actually a lot simpler than you might think.
• At SSCC, we almost always recommend heat instead of ice to treat an injury, whether that’s an acute injury like a sprain or something more chronic like joint pain or low back pain. Of course, that answer has a bit of nuance, so let’s dig a little deeper into heat vs. ice for injury and pain.
Table of Contents:
- The Great Heat vs. Ice Debate
- Why Heat is Better Than Ice
- Wet Heat vs. Dry Heat
- How Often to Use Heat
- Why You Shouldn’t Ice an Injury
- When to Use Ice (Sparingly)
- When to Alternate Ice and Heat
- Ice Debunked: Use Heat for Injury Instead
- References
The Great Heat vs. Ice Debate
If you’ve seen an old-school chiropractor or physiotherapist before, you might have heard about the RICE methodology — rest, ice, compression, elevation — for treating tissue injuries. This was the gold standard of treatment for many years in our profession.
However, most practitioners today know that applying ice to an injury can actually slow the healing process and in some cases seriously compromise it. Today, we recommend applying heat to the injury and only using ice periodically in the first 24 hours or so for pain management.
Why Heat is Better Than Ice
The reason behind using heat instead of ice for an injury isn’t about the injury itself. Rather, it’s about using heat to dilate the blood vessels around the injury so that you bring more fresh blood with nutrients to the area and carry waste products away.
I tell my patients that you’re carrying the groceries in and taking the trash out. You want the fresh food in the fridge and the garbage outside in the trash can, not all mixed up together. Similarly, applying heat gets your blood supply moving to make the healing process easier.
Wet Heat vs. Dry Heat
Okay, now you know to use heat instead of ice for injury or chronic pain. From here we have two options: wet heat or dry heat. I always recommend wet heat over dry heat to my patients. For example, a hot Epsom salt bath is extremely beneficial to soothe muscles, relieve pain, and introduce a deep relaxation to the body that supports healing. If you don’t have access to a bathtub, standing in a hot steamy shower will do the trick.
Another option we have at our clinic is a cherry pit pillow, which you can heat up in your microwave and it becomes slightly moist. Then you apply that directly over the injury and rinse and repeat as needed. The last topical option is to take a damp towel or washcloth and heat it in the microwave, but you have to be extremely careful not to scald yourself as the towel can heat unevenly.
A few other strategies: if you have access to a steam room or sauna that’s great, just make sure to stay well-hydrated. Dry heat such as a heating pad is also fine to use if that’s your only choice available, but moist heat is better.
How Often to Use Heat
Only apply heat to your injury for 20 minutes at a time max. You can do this several times a day, but you never want constant heat on the injury. This is a fast track to stiffness later on. For example, I never recommend sleeping on a heating pad because a) it’s a serious fire hazard, and b) you’ll just end up with stiff muscles in the morning.
Why You Shouldn’t Ice an Injury
Applying ice to an injury restricts blood vessels and therefore restricts the delivery of nutrients and removal of waste products from the injury site. This is the opposite of what we want for long-term healing. Using ice basically works against the body’s own recovery and healing processes. We want to support the body’s natural healing ability and simply allow it to do what it already knows how to do: repair and regenerate itself. (Not to mention heat typically feels better, especially after the first 48 hours of an injury or in cases of chronic pain.)
When to Use Ice (Sparingly)
You can use ice within the first 24 hours of injury, to bring pain and swelling down in the area. But again, remember that some swelling is good — it’s a sign of the inflammatory process and nutrient delivery to the area. Same as heat, only ice for up to 20 minutes at a time. Then, switch to heat for as long as it takes to recover.
When to Alternate Ice and Heat
I’ll recommend alternating ice and heat in cases where we want to instigate a pumping motion in the body. For example, those with lymphedema, fluid buildup, or a lot of stagnant inflammation in the body would benefit from this method. Alternate 20 minutes of heat and 20 minutes of ice to dilate and then constrict the blood vessels. This creates a pumping effect to move blood back to the heart where it can be recirculated throughout the body.
Ice Debunked: Use Heat for Injury Instead
Hopefully, this helps answer the age-old ice vs. heat question and you’ll know exactly what to do the next time you tweak your back or roll an ankle. (It happens to the best of us!) If you want an expert clinical evaluation to make sure you’re on the right track, don’t hesitate to reach out to us at Simply Southern Chiropractic Center. We’ll have you pain-free and mobile in no time. Schedule an appointment with us today!
References
Wang ZR, Ni GX. Is it time to put traditional cold therapy in rehabilitation of soft-tissue injuries out to pasture?. World J Clin Cases. 2021;9(17):4116-4122. doi:10.12998/wjcc.v9.i17.4116
Malanga GA, Yan N, Stark J. Mechanisms and efficacy of heat and cold therapies for musculoskeletal injury. Postgrad Med. 2015;127(1):57-65. doi:10.1080/00325481.2015.992719